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. big about when medicare was introduced. i think we have to be patient with that. this is a big question about engaging with providers. i think the kind of comments, the doctors do what you pay them to do. this is going to be a change in focusing on delivering the highest quality care while at the same time providing excellent customer service. that is a different paradigm. i think it is going to be an educational process, a changing of the culture. think about the large hospitals that have multiple product -- private practitioners or inside a university system, where even the university does take into account quality often times in the promotion of an appointment process. it is going to be a big change, and there would be bumps in the road. we changed to reward the bull basin quality outcomes. we have never been charged with doing that. we just want to do as many big volume cases that are cases. that is going to change. one of the things that i am concerned about is when you use volume as a metric for reimbursement, to have a level playing field to define what the quality param
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